Indications for the use of apheresis technologies in managing lupus erythematosus have undergone numerous conceptual changes since the procedure was automated in the 1960s and first attempted for systemic lupus erythematosus (SLE) in 1974. Once thought to be a promising treatment for a variety of aspects of SLE, apheresis has been relegated to occupying a few important niches as an adjunct in managing the disorder. This article will review the history, physiology and rationale of apheresis pertaining to SLE. A focused critical review of pertinent literature is presented, along with specific recommendations relating to the place of apheresis in the lupus therapeutic spectrum.